Pain physician
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Spinal cord stimulation (SCS) is an established treatment option for chronic pain. Prior to permanent implantation, temporary trials are performed to evaluate the SCS treatment. During the trial period, it is common for the patients to experience changes in paresthesias. However, it is unclear what the role of lead migration is, if any, in the changes in paresthesia. ⋯ This case series demonstrates continued support for the role of the width of the cerebral spinal fluid space as the significant factor on paresthesia changes in SCS with respect to postural changes, even during the trial period.
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Review Meta Analysis
Prevalence of pain among nonmedical prescription opioid users in substance use treatment populations: systematic review and meta-analyses.
Prescription opioid analgesics (POA) are widely used in the pharmacotherapeutic treatment of acute and chronic pain in North America, where nonmedical prescription opioid use (NMPOU) has become a substantial public health concern in recent years. Existing epidemiological data suggest an association between NMPOU and pain problem symptoms in different populations, including samples in substance use treatment, although the extent of these correlations has not been systematically assessed. ⋯ Pain symptoms are disproportionately elevated in substance use treatment samples reporting NMPOU. Effective measures to prevent and treat NMPOU are urgently needed, although a substantive extent of NMPOU observed in this specific context may relate directly or indirectly to the presence of pain, e.g., either as an expression of ineffective pain care or as a consequence of previous POA-based interventions. At the same time, effective ways to treat and address ongoing pain issues in NMPOU samples need to be implemented, which may require ongoing opioid-based pharmacotherapeutic care aimed at both pain and dependence.
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Randomized Controlled Trial Multicenter Study
Randomized clinical trial evaluating transdermal Ibuprofen for moderate to severe knee osteoarthritis.
Osteoarthritis is a common condition, typically treated with orally administered analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). Chronic administration of NSAIDs, serotonin-norepinephrine reuptake inhibitors (SNRIs, i.e., duloxetine), and opioid medications (i.e., tramadol) is regularly associated with multiple, serious side effects, in part due to the route of administration. Transdermal delivery of NSAIDs, such as ibuprofen, represents a potentially alternative treatment for this inflammatory pain condition with a better therapeutic profile. ⋯ NCT01496326.
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The use of opioid analgesics in the treatment of chronic pain conditions has long been controversial. They have been reported to be relatively safe when prescribed with caution, but a brief and valid instrument to estimate a person's risk of addiction is still missing. ⋯ We found differences in questionnaire responses between patients with an opioid addiction and patients suffering from chronic pain to be dependent upon the prevalence of current or former addiction, psychiatric history, attitudes towards medication, and ideas about the origin of pain. We believe these factors have predictive value in estimating a patient with pain's risk of addiction.